Provider Demographics
NPI:1174914881
Name:ALABAMA EYE PHYSICIANS AND SURGEONS, P.C.
Entity type:Organization
Organization Name:ALABAMA EYE PHYSICIANS AND SURGEONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:STURRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-446-0872
Mailing Address - Street 1:5937 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-9317
Mailing Address - Country:US
Mailing Address - Phone:334-446-0872
Mailing Address - Fax:334-446-0893
Practice Address - Street 1:5937 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-9317
Practice Address - Country:US
Practice Address - Phone:334-446-0872
Practice Address - Fax:334-446-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.30046207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002006500Medicaid
GA80637829AMedicaid
AL117610Medicaid
AL102I183451Medicare PIN
GA80637829AMedicaid
AL1027G09402Medicare PIN
FLDE398ZMedicare PIN